Poor public health services are pitting doctors and patients against each other

Doctors are under siege; patients are aggrieved. This is essentially what is being played out in public hospitals, most recently in Maharashtra where last month, in five separate incidents, doctors in public hospitals were assaulted by angry relatives of patients alleging negligence. Similar incidents have been reported from Delhi, Surat, Ahmedabad, Bulandshahr and Chennai in the last couple of years. Such violence against doctors is not peculiar to India. Lancet and the British Medical Journalreport increasing attacks on doctors in the Indian subcontinent and China.

The common thread running through these incidents is that most attacks occur in public hospitals where the resources are stretched thin to cover a large section of the population and the doctors (mostly junior) are too overworked to deal empathetically with anxious and tense patients’ relatives. An Indian Medical Association 2015 survey of 500 doctors found that nearly 75% of the respondents had faced attacks and intimidation.

While doctors are overworked, patients and their relatives overwhelmingly point to discourteous doctors and uncooperative hospital staff, insufficient diagnostic equipment and essential drugs and lack of information about the patient’s condition and the prognosis. Together these exacerbate their anxiety. They are also frustrated with being asked to buy medicines and services from private agencies outside the hospital.

From the perspective of doctors, especially in public hospitals, there is the pressure to provide emergency treatment even as the patient’s family and friends surround them expecting miracles. In many of the cases of assault, so-called local “leaders” demanding immediate attention for “their” patient led the charge. And after working back-breaking hours in resource-poor conditions—one of the doctors attacked in Mumbai recently had worked for 36 hours almost non-stop when the incident occurred—their only “rest” is in hostels with abysmal amenities.

Public perception of doctors as “life-givers” has also drastically changed with the increasing privatisation and commercialisation of medical healthcare and the stories of crass insensitivity by private doctors towards patients who cannot afford their high rates. As a result, even doctors doing their best in difficult conditions are perceived as indifferent. Public hospitals have to bear the brunt of this lack of trust as often patients are taken there after their condition has deteriorated in private hospitals and the family is resentful about the heavy expenditure incurred and poor treatment given.

Fourteen states have enacted laws to protect doctors and prevent such violence but enforcement is uniformly weak. For example, Maharashtra Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage or Loss to Property) Act, 2010, makes offences against doctors non-bailable with imprisonment up to three years and a fine of ₹50,000. The offender could also be asked to pay twice the amount of damage caused to the institution’s property. However, in the last three years, 53 cases of doctors being beaten up were registered but there has not been a single conviction. According to media reports, almost all those arrested for the recent acts of violence have been granted bail.

Apart from laws, many hospitals resort to increasing security immediately after such incidents. For example, the Deen Dayal Upadhyay Hospital, the largest government hospital in Delhi, hired “bouncers” after witnessing one attack a month and after the staff stopped work in protest 20 times in the last six years. Yet increased security is at best a piecemeal measure. It could backfire and drive a deeper wedge between the community and doctors. Senior doctors—sensitive to the worsening state of affairs—have initiated steps to teach their younger colleagues to communicate better with patients’ relatives. A few public hospitals have taken the lead in doing this. Medical education pays little attention to this aspect and even if it did, the inability of the doctors to understand the socio-economic backgrounds of their patients ends up making a bad situation worse.

At the same time, while empathetic and communicative doctors are needed, that alone will not suffice. The sheer volume of patients thronging the country’s public hospitals calls for deeper structural changes. India has a pathetically low budget allocation for health services. Also the patient–doctor ratio of 7:1 (Maharashtra and Bihar have the worst ratios in the country) is far from adequate. When a crisis looms, as provoked by the recent clash between doctors and patients in Maharashtra, piecemeal measures are taken. However, unless the larger questions of spending on health and enhancing the capacity of public hospitals to deliver more effective healthcare are addressed, doctors and patients will continue to be viewed as adversaries.

See more at: http://www.epw.in/journal/2017/13/editorials/drawing-blood.html#sthash.cIl3sSIN.dpuf